RheumaView™ · RV-003 · Case Study
The Same Films, Read Two Ways
A multi-modal, longitudinal axial/pelvic case — one conventional radiology report beside a RheumaView™ structured radiographic report at three rendering depths, with cross-modal MRI and EMG/NCS context and a limited longitudinal sacroiliac comparison.
Complexity: Multi-modality · longitudinal · radiograph + MRI + EMG/NCS · cross-modalityWhy this is a multi-modality / longitudinal case
This is a multi-modality, longitudinal case: current radiographs across five axial/pelvic regions, a prior (~4-year) sacroiliac/pelvic radiographic comparison, plus cervical / lumbar / sacroiliac MRI and bilateral EMG/NCS integrated as outside-report text. Its boundaries are explicit: matched radiographic comparison exists only for the sacroiliac/pelvic region; MRI and EMG/NCS are report-text integrations rather than direct source-image re-reads; and no DEXA was provided. See how case complexity scales.
Conventional report vs RheumaView™ structured report
Same radiographs, read two ways. On wide screens both reports sit side by side; on narrow screens use the tabs. Adequacy and data-needs blocks are shared across all rendering depths.
CERVICAL SPINE
FINDINGS: Vertebral alignment is maintained. Mild straightening of the normal cervical lordosis. Minor anterior osteophytes and slight disc space narrowing at the lower cervical levels. The odontoid is intact and the atlantoaxial relationship is preserved. No fracture or destructive bony lesion. Dental amalgam noted.
IMPRESSION: Mild degenerative changes. No acute abnormality.
THORACIC SPINE
FINDINGS: Vertebral body heights and alignment are preserved. Mild degenerative changes with minor anterior endplate spurring. No acute compression deformity. Visualized lung fields unremarkable within the limits of a bone technique.
IMPRESSION: Mild degenerative change. No acute finding.
LUMBAR SPINE
FINDINGS: Five lumbar-type vertebrae. Alignment preserved without spondylolisthesis. Mild disc space narrowing at the lumbosacral junction with minor endplate spurring. Facet joints otherwise unremarkable. Surgical clips projected over the pelvis. No fracture.
IMPRESSION: Mild degenerative disc disease, lower lumbar spine. Otherwise unremarkable.
PELVIS AND HIPS
FINDINGS: Hip joint spaces maintained bilaterally without significant degenerative change. No fracture or focal bony lesion. Pubic symphysis unremarkable. Surgical clips in the pelvis.
IMPRESSION: No significant osseous abnormality of the hips or pelvis.
SACRUM / SACROILIAC JOINTS
FINDINGS: The sacroiliac joints are partially obscured by overlying bowel gas. No definite erosion, sclerosis, or joint space abnormality appreciated on this plain radiograph. Sacrum intact. Compared with the prior dedicated sacroiliac views (~4 years earlier), no significant interval change.
IMPRESSION: No definite sacroiliac abnormality; evaluation limited by technique. No significant change since the prior study (~4 years earlier).
Electronically signed by the interpreting radiologist.
Current radiographs are adequate for structural assessment of the cervical, thoracic, and lumbar spine, sacroiliac joints, pelvis, and hips. Longitudinal comparison is anatomically matched only for the sacroiliac/pelvic region because prior cervical, thoracic, and lumbar radiographs were not provided. Projection naming in headers is required; numeric-only view counts are insufficient.
Cervical spine
Count: focal structural abnormalities centered in the lower cervical spine, predominantly C5-C6 and C6-C7.
Distribution: lower cervical, multicomponent degenerative pattern.
Laterality: near-symmetric overall; mild bilateral foraminal involvement.
Morphology / extent: mild straightening of the cervical lordosis. Trace retrolisthesis of C5 on C6. Disc-space narrowing is grade 2/4 at C5-C6 and grade 1/4 at C6-C7. Small anterior endplate osteophytes at C5-C6 and C6-C7. Mild posterior/uncovertebral spurring at C5-C6 and C6-C7. Mild bilateral osseous foraminal narrowing at C5-C6 and C6-C7 on the oblique views. Mild lower cervical facet hypertrophic change, greatest at C5-C6/C6-C7. Vertebral body heights preserved. Atlantodental alignment maintained. No definite odontoid erosion, syndesmophyte, ankylosis, or definite inflammatory corner lesion on the provided radiographs.
Symmetry pattern: near-symmetric degenerative distribution.
Confidence: high for degenerative/alignment findings; moderate for exclusion of very subtle inflammatory corner abnormalities on radiographs.
Visible soft tissues: physiologic mineralization of laryngeal cartilaginous structures. Tiny punctate/short linear anterior neck calcific density, low-volume incidental appearance. No prevertebral soft-tissue thickening.
Thoracic spine
Count: multilevel abnormalities involving the lower thoracic spine, greatest from approximately T7-T8 through T11-T12.
Distribution: mid/lower thoracic, contiguous degenerative disc-endplate pattern, maximal at T10-T11 and T11-T12.
Laterality: no meaningful side dominance on lateral view; mild asymmetric paraspinal osteophytic prominence on AP view.
Morphology / extent: mild thoracolumbar levoconvex curvature on AP view. Disc-space narrowing: grade 1/4 at T7-T8, T8-T9, and T9-T10; grade 2/4 at T10-T11; grade 2–3/4 at T11-T12. Mild endplate sclerosis at T10-T11 and mild-to-moderate at T11-T12. Small anterior endplate osteophytes from approximately T7-T8 through T11-T12. Subtle posterior disc-osteophyte contour prominence at T10-T11 and T11-T12. Vertebral body heights preserved without definite compression fracture. No definite flowing anterior ossification across four contiguous thoracic levels. No definite bridging syndesmophytes or ankylosis.
Symmetry pattern: non-ankylosing, degenerative-predominant lower thoracic pattern.
Confidence: high.
Visible extraspinal soft tissues: two small calcified nodular densities project in the posterior subcutaneous tissues on the lateral views, left posterior lower thoracic/upper lumbar soft tissues, incidental. Mild biapical pleural-parenchymal scarring/thickening suggested on AP views, low confidence.
Lumbar spine
Count: multilevel abnormalities involving the thoracolumbar junction and lumbar spine, greatest at T12-L1 and L1-L2, with additional lower-lumbar facet change.
Distribution: thoracolumbar/upper lumbar degenerative disc-endplate pattern with separate lower-lumbar posterior element involvement.
Laterality: near-symmetric disc-endplate degeneration; bilateral lower-lumbar facet involvement.
Morphology / extent: five lumbar-type vertebral bodies. Mild levoconvex lumbar curvature centered approximately at L2-L3/L3. Disc-space narrowing: grade 2/4 at T12-L1, 2/4 at L1-L2, 1/4 at L2-L3, 1/4 at L3-L4, 0–1/4 at L4-L5, 0–1/4 at L5-S1. Vacuum disc phenomenon at T12-L1 and L1-L2. Mild endplate sclerosis at T12-L1 and mild-to-moderate at L1-L2. Small anterior endplate osteophytes at T12-L1, L1-L2, and L2-L3, with smaller superior endplate spurring at L3. Mild facet arthropathy bilaterally at L4-L5 and L5-S1; low-grade facet change also at L3-L4. No definite pars defect. No measurable spondylolisthesis. Vertebral body heights preserved. No definite syndesmophyte or ankylosis.
Symmetry pattern: degenerative-predominant, multilevel, without destructive inflammatory axial remodeling.
Confidence: high for degenerative findings; moderate for exclusion of very subtle inflammatory corner abnormalities on radiographs.
Sacroiliac joints
Count: bilateral sacroiliac abnormalities involving the inferior compartments of both joints.
Distribution: bilateral inferior-predominant pattern; iliac-sided greater than sacral-sided; left slightly greater than right.
Laterality: bilateral, mildly asymmetric with greater left conspicuity.
Morphology / extent: definite inferior iliac-sided subchondral sclerosis bilaterally (mild overall burden, left greater than right) with subtler inferior sacral-sided sclerosis bilaterally. Mild inferior articular cortical irregularity bilaterally. Superior joint spaces preserved bilaterally, JSN grade 0/4 superiorly on both sides. Subtle inferior left SI crowding/narrowing present but below threshold for definite erosive inflammatory joint-space loss. No partial or complete ankylosis. No definite erosive cortical defect with high confidence. Tiny pseudoerosive/subcortical lucent notches along the inferior margins bilaterally, greater on the left, remain low-confidence only.
Symmetry pattern: near-symmetric bilateral inferior-predominant pattern, left slightly greater than right.
Confidence: high for sclerosis, preserved superior joint spaces, and absence of ankylosis; low-to-moderate for the tiny pseudoerosive notches.
Pelvis / hips / pubic symphysis
Count: mild non-destructive abnormalities at both hips and pubic symphysis.
Distribution: bilateral hips with minimal acetabular spurring and subtle head-neck offset loss; minimal central pubic symphyseal degeneration.
Laterality: bilateral, left greater than right for head-neck offset loss.
Morphology / extent: hip joint spaces preserved bilaterally, JSN grade 0/4. Minimal superior acetabular marginal spurring bilaterally. Mild loss of femoral head-neck offset bilaterally, subtle, greater on the left. Femoral head sphericity preserved. No femoral head collapse, destructive lesion, or definite erosive arthropathy. Minimal marginal irregularity / very mild degenerative change at the pubic symphysis without diastasis. IUD projects over the pelvis.
Symmetry pattern: largely symmetric hips with mild left-greater-than-right contour prominence.
Confidence: high.
Comparison
Compared with the prior (~4-year) sacroiliac/pelvic radiographs, the bilateral inferior-predominant sacroiliac sclerosis remains present in the same zonal distribution, again slightly greater on the left, without definite new erosive defect, ankylosis, or convincing new superior-compartment joint-space loss. Mild inferior cortical irregularity remains bilaterally. Tiny low-confidence inferior pseudoerosive/lucent marginal notches remain non-definite and not convincingly progressed. The included hips remain without destructive interval change on the matched field. No prior matched cervical, thoracic, or lumbar radiographs were available for spinal temporal assessment.
Required numeric deltas, matched sacroiliac/pelvic region
- Δerosions: 0 definite
- ΔJSN: 0 definite superior-compartment progression
- Δosteophytes: 0
- Δsclerosis: 0 overall burden
- Δalignment: 0
- Δankylosis: 0
- ΔmTSS / ΔmSASSS / ΔKL-OARSI: not applicable on the provided matched comparison set
Impression
- Stable bilateral sacroiliac structural abnormality across the ~4-year interval (baseline → current), characterized by mild inferior-predominant iliac-sided greater than sacral-sided subchondral sclerosis and mild inferior articular cortical irregularity, slightly greater on the left.
- No definite sacroiliac erosive progression, no definite superior-compartment joint-space loss, and no ankylosis on the provided longitudinal sacroiliac comparison. Tiny inferior pseudoerosive/lucent marginal notches remain low-confidence and non-definite.
- Multilevel axial degenerative change outside the sacroiliac joints, including focal lower cervical spondylosis greatest at C5-C6/C6-C7 with mild bilateral foraminal narrowing, lower thoracic degenerative disc-endplate change greatest at T10-T11/T11-T12, and thoracolumbar/upper lumbar degenerative disc disease greatest at T12-L1/L1-L2 with vacuum phenomenon, plus mild lower-lumbar facet arthropathy.
- Preserved vertebral body heights without compression fracture. No definite syndesmophyte, bridging ankylosis, or DISH-type flowing ossification pattern on the submitted axial series.
- Overall: mixed axial/pelvic pattern with stable non-ankylosing sacroiliac abnormalities and superimposed multilevel degenerative spinal change; current radiographs do not show definite progressive radiographic axial inflammatory destructive change.
EMR Summary
Longitudinal radiographs show a mixed structural pattern with stable bilateral sacroiliac abnormalities and superimposed multilevel axial degeneration. The sacroiliac joints demonstrate mild bilateral inferior-predominant iliac-sided greater than sacral-sided sclerosis with mild inferior cortical irregularity, slightly greater on the left, without definite erosive progression, ankylosis, or convincing interval joint-space loss versus the prior (~4-year) study. The spine shows lower cervical spondylosis, lower thoracic disc-endplate degeneration, and thoracolumbar/upper lumbar degenerative disc disease with vacuum phenomenon and mild lower-lumbar facet arthropathy. Pattern tag: mixed degenerative-predominant. Progression tag: stable in the matched sacroiliac region. Inflammatory features tag: no definite radiographic erosive sacroiliitis or ankylosing spinal change on the submitted films. DISH tag: absent. Fracture tag: absent.
Cervical spine
Mild straightening of the cervical lordosis. Trace retrolisthesis of C5 on C6. Mild-to-moderate disc space narrowing at C5-C6 and mild at C6-C7. Small anterior endplate osteophytes and mild posterior/uncovertebral spurring at C5-C6/C6-C7. Mild bilateral osseous foraminal narrowing at C5-C6 and C6-C7 on the oblique views. Mild lower cervical facet hypertrophic change. Vertebral body heights preserved. Atlantodental alignment maintained. No definite odontoid erosion, syndesmophyte, ankylosis, or definite inflammatory corner lesion on the provided radiographs.
Thoracic spine
Mild thoracolumbar levoconvex curvature. Multilevel lower thoracic degenerative disc-endplate change, including mild disc space narrowing at T7-T8, T8-T9, and T9-T10, mild-to-moderate at T10-T11, and moderate at T11-T12. Mild endplate sclerosis at T10-T11 and mild-to-moderate at T11-T12. Small multilevel anterior endplate osteophytes from approximately T7-T8 through T11-T12. Subtle posterior disc-osteophyte contour prominence at T10-T11 and T11-T12. Vertebral body heights preserved without definite compression deformity. No definite flowing anterior ossification across four contiguous levels, bridging syndesmophytes, or ankylosis. Two small calcified nodular densities project in the posterior subcutaneous soft tissues on the lateral views, incidental.
Lumbar spine
Five lumbar-type vertebral bodies. Mild levoconvex lumbar curvature centered approximately at L2-L3/L3. Multilevel degenerative disc-endplate change, greatest at the thoracolumbar/upper lumbar junction. Disc space narrowing mild-to-moderate at T12-L1, moderate at L1-L2, mild at L2-L3, minimal-to-mild at L3-L4, minimal at L4-L5 and L5-S1. Vacuum disc phenomenon at T12-L1 and L1-L2. Mild endplate sclerosis at T12-L1 and mild-to-moderate at L1-L2. Small anterior endplate osteophytes at T12-L1, L1-L2, and L2-L3, with smaller spurring at L3 superior endplate. Mild facet arthropathy at L4-L5 and L5-S1 bilaterally, low-grade also at L3-L4. No definite pars defect, measurable spondylolisthesis, syndesmophyte, or ankylosis. Vertebral body heights preserved.
Sacroiliac joints
Bilateral sacroiliac joint abnormalities in an inferior-predominant near-symmetric distribution, slightly greater on the left. Definite inferior iliac-sided subchondral sclerosis bilaterally, with subtler inferior sacral-sided sclerosis. Mild inferior articular cortical irregularity bilaterally. Superior joint spaces preserved bilaterally. Subtle mild inferior left sacroiliac crowding without definite superior-compartment joint-space loss. No partial or complete ankylosis. No definite erosive cortical defect with high confidence. Tiny low-confidence pseudoerosive/subcortical lucent notches along the inferior articular margins bilaterally, greater on the left.
Pelvis / hips / pubic symphysis
Hip joint spaces preserved bilaterally. Minimal superior acetabular marginal spurring bilaterally. Mild loss of femoral head-neck offset bilaterally, subtle, greater on the left. Femoral head sphericity preserved. No femoral head collapse, destructive lesion, or definite erosive arthropathy. Minimal marginal irregularity / very mild degenerative change at the pubic symphysis without diastasis. IUD projects over the pelvis.
Comparison
Compared with the prior (~4-year) sacroiliac/pelvic radiographs, the bilateral inferior-predominant sacroiliac sclerosis remains present in the same zonal distribution, again slightly greater on the left, without definite new erosive defect, ankylosis, or convincing new superior-compartment joint-space loss. Mild inferior cortical irregularity remains bilaterally. Tiny low-confidence pseudoerosive/lucent inferior marginal notches remain non-definite and not convincingly progressed. No prior cervical, thoracic, or lumbar radiographs were provided for matched temporal assessment of those spinal regions.
Impression
- Stable bilateral sacroiliac structural abnormality across the ~4-year interval (baseline → current), mild inferior-predominant iliac-sided greater than sacral-sided sclerosis and mild inferior cortical irregularity, slightly greater on the left.
- No definite sacroiliac erosive progression, no definite superior-compartment joint-space loss, and no ankylosis. Tiny inferior pseudoerosive/lucent marginal notches remain low-confidence and non-definite.
- Multilevel axial degenerative change, greatest at C5-C6/C6-C7, T10-T11/T11-T12, and T12-L1/L1-L2 with vacuum phenomenon, plus mild lower-lumbar facet arthropathy.
- Preserved vertebral body heights without compression fracture. No definite syndesmophyte, bridging ankylosis, or DISH-type flowing ossification on the submitted axial series.
- Mixed axial/pelvic structural pattern with stable non-ankylosing sacroiliac abnormalities and superimposed multilevel degenerative spinal change.
Findings
Stable bilateral sacroiliac abnormalities with mild inferior-predominant iliac-sided greater than sacral-sided subchondral sclerosis and mild inferior articular cortical irregularity, slightly greater on the left. Superior sacroiliac joint spaces remain preserved. No definite erosions or ankylosis. Tiny inferior pseudoerosive/lucent marginal notches remain low-confidence and non-definite. Multilevel axial degenerative change, including lower cervical spondylosis greatest at C5-C6/C6-C7 with mild bilateral osseous foraminal narrowing, lower thoracic degenerative disc-endplate change greatest at T10-T11/T11-T12, and thoracolumbar/upper lumbar degenerative disc disease greatest at T12-L1/L1-L2 with vacuum phenomenon and mild lower lumbar facet arthropathy. Hip joint spaces preserved bilaterally. Minimal acetabular spurring bilaterally. Mild loss of femoral head-neck offset bilaterally, greater on the left. Minimal pubic symphyseal degenerative change. IUD noted. Two small posterior subcutaneous calcified nodular densities project on lateral thoracolumbar views.
Impression
- Stable bilateral non-ankylosing sacroiliac structural abnormality across the ~4-year interval (baseline → current), slightly greater on the left, without definite erosive progression.
- No definite superior sacroiliac joint-space loss or ankylosis.
- Multilevel cervical, thoracic, and lumbar degenerative/spondylotic change, greatest at C5-C6/C6-C7, T10-T11/T11-T12, and T12-L1/L1-L2.
- No definite radiographic ankylosing spinal pattern on the provided study.
- Longitudinal comparison anatomically matched only for the sacroiliac/pelvic region; no prior cervical, thoracic, or lumbar radiographs for matched spinal temporal assessment.
- Tiny inferior SI pseudoerosive/lucent notches remain low-confidence on radiographs; activity/erosion characterization would require dedicated MRI/US correlation.
- No DEXA dataset provided; bone-mineral / fragility outputs non-computable.
- Weight-bearing status not specified for the axial series.
- MRI and EMG/NCS are integrated here as outside-report text, not direct source-image re-read.
Research / analytics addendum
Preview of the structured analytic depth. The first matrix is shown; the full addendum (22 tables, formulas, cross-modal concordance, synthesis) expands below.
A. Quantitative Radiologic Measures
A1. Region-level structural burden matrix
| Region | Dominant structural findings | Distribution | Severity class | Numeric burden (0–4) |
|---|---|---|---|---|
| Cervical XR · current | Straightening, trace C5/C6 retrolisthesis, C5-C6>C6-C7 disc loss, uncovertebral/posterior spurring, mild bilateral foraminal narrowing | Lower cervical | Mild–moderate focal | 1.5 |
| Thoracic XR · current | T7-T12 disc-endplate degeneration, greatest T10-T11/T11-T12 | Lower thoracic contiguous | Mild–moderate | 1.75 |
| Lumbar XR · current | T12-L2 dominant disc degeneration, vacuum at T12-L1/L1-L2, mild lower lumbar facet arthropathy | Thoracolumbar/upper lumbar predominant | Moderate focal / mild global | 2.0 |
| SI joints XR · prior + current (~4-yr interval) | Inferior iliac-sided > sacral-sided sclerosis, mild inferior cortical irregularity, no definite erosions/ankylosis | Bilateral, left slightly greater | Mild | 1.25 |
| Hips/pelvis XR · current | Minimal acetabular spurring, mild reduced head-neck offset, minimal pubic symphyseal degeneration | Bilateral, left slightly greater offset loss | Minimal–mild | 0.5 |
| Cervical MRI · ~4 yr before current | C4-C5 small central protrusion with mild canal stenosis; C5-C6 mild left foraminal stenosis; C6-C7 small central protrusion with minimal canal stenosis and left foraminal stenosis | Lower cervical | Mild | 1.25 |
| Cervical MRI · ~2–3 yr before current (report date not explicitly stated) | C4-C5 posterior disc-osteophyte complex with mild central stenosis; C5-C6 left uncovertebral hypertrophy with mild left foraminal stenosis; C6-C7 posterior disc-osteophyte complex with minimal central stenosis | Lower cervical | Mild | 1.25 |
| Lumbar MRI · current +~1 mo | L5-S1 disc desiccation, minimal broad-based bulge, minimal bilateral foraminal stenosis | Focal L5-S1 | Minimal–mild | 0.75 |
| Pelvic/SI MRI · current +~3 wk | Mild marrow-edema-like signal on both sides of both SI joints, no erosions, no effusion; L5-S1 shallow central protrusion with annular fissure | Bilateral SI + L5-S1 | Mild inflammatory/reactive MRI signal burden | 1.25 |
A2. XR disc-space / compartment grading
| Structure | Grade |
|---|---|
| C5-C6 disc space loss | 2/4 |
| C6-C7 disc space loss | 1/4 |
| T7-T8 | 1/4 |
| T8-T9 | 1/4 |
| T9-T10 | 1/4 |
| T10-T11 | 2/4 |
| T11-T12 | 2–3/4 |
| T12-L1 | 2/4 |
| L1-L2 | 2/4 |
| L2-L3 | 1/4 |
| L3-L4 | 1/4 |
| L4-L5 | 0–1/4 |
| L5-S1 | 0–1/4 on XR; minimal bulge/desiccation on MRI |
| SI superior JSN right | 0/4 |
| SI superior JSN left | 0/4 |
| Hip JSN right | 0/4 |
| Hip JSN left | 0/4 |
A3. SI structural scorecard
| Feature | Right | Left | Summary |
|---|---|---|---|
| Inferior iliac-sided sclerosis | 1.0 | 1.25 | Mild, left > right |
| Inferior sacral-sided sclerosis | 0.5 | 0.5 | Subtle bilateral |
| Inferior cortical irregularity | 1.0 | 1.0 | Mild bilateral |
| Definite erosions on XR | 0 | 0 | Absent |
| Low-confidence pseudoerosive notches on XR | 0.5 | 0.75 | Present, non-definite |
| Ankylosis on XR | 0 | 0 | Absent |
| MRI marrow-edema-like signal | 1.0 | 1.0 | Mild bilateral |
| MRI erosions | 0 | 0 | Absent |
| MRI effusion | 0 | 0 | Absent |
Derived SI composite burden
A4. Soft-tissue / incidental burden capture
| Location | Finding | Burden |
|---|---|---|
| Posterior lower thoracic/upper lumbar soft tissues | Two small calcified nodular densities on lateral XR | Minimal |
| Anterior neck soft tissues | Tiny punctate/linear calcific density | Minimal |
| Laryngeal region | Physiologic cartilaginous mineralization | Physiologic |
| Lungs apices | Mild biapical pleural-parenchymal scarring/thickening, low-confidence on XR | Minimal / low-confidence |
B. Longitudinal & Temporal Metrics
B1. Chronology map
| Relative timing | Modality | Region | Key content |
|---|---|---|---|
| ~4 yr before current | XR | SI/pelvis | Mild bilateral inferior-predominant SI sclerosis/irregularity |
| ~4 yr before current (~6 wk after prior SI XR) | MRI w/wo contrast | Cervical spine | Mild C4-C5, C5-C6, C6-C7 degenerative/protrusive disease; no cord abnormality |
| ~2.4 yr before current (≈29 mo) | EMG/NCS | Upper extremities | Moderate bilateral carpal tunnel syndrome; no acute cervical radiculopathy |
| ~2.4 yr before current (≈29 mo) | EMG/NCS | Lower extremities | Normal; no large-fiber neuropathy or acute lumbosacral radiculopathy |
| current (index) | XR | Cervical/thoracic/lumbar/SI/pelvis/hips | Mixed axial degenerative pattern + stable non-ankylosing SI structural abnormality |
| current +~3 wk | MRI | SI joints/pelvis | Mild bilateral SI marrow-edema-like signal, no erosions/effusion |
| current +~1 mo | MRI | Lumbar spine | Mild L5-S1 degenerative change |
| ~2–3 yr before current; report date not explicitly stated | MRI | Cervical spine | Mild lower cervical spondylotic degenerative changes |
B2. Matched XR longitudinal delta matrix (prior SI XR → current SI XR, ~4-year interval)
| Parameter | Prior (~4 yr earlier) | Current | Delta |
|---|---|---|---|
| Definite erosions | 0 | 0 | 0 |
| Superior-compartment JSN | 0 | 0 | 0 |
| Inferior iliac-sided sclerosis | Mild bilateral | Mild bilateral | 0 |
| Inferior sacral-sided sclerosis | Subtle bilateral | Subtle bilateral | 0 |
| Inferior cortical irregularity | Mild bilateral | Mild bilateral | 0 |
| Ankylosis | 0 | 0 | 0 |
| Left-right asymmetry class | Low | Low | 0 |
B3. Cross-modality temporal stability metrics
| Metric | Value | Interpretation |
|---|---|---|
| XR SI Stability Index | 0.95 | High stability |
| XR temporal stability score | 0.96 | Stable |
| CDC-adjusted confidence | 0.88 | High-moderate |
| MRI/XR SI concordance | 0.74 | Moderate concordance: chronic non-erosive structural changes + mild active/reactive marrow signal |
| Whole-case structural drift class | Low drift | No destructive progression demonstrated |
| Cross-modal interval coherence | 0.81 | Imaging modalities broadly compatible |
B4. Composite Disease-Trajectory Index (case-level proxy)
Using stable SI XR deltas, mild current SI MRI edema-like signal, and absent EMG radiculopathy:
- CDTI value: 0.22
- Class: I / low structural drift
- Trajectory: stable structural course with low-level cross-modal inflammatory/reactive signal
- Primary drivers: stable SI sclerosis + mild bilateral SI marrow-edema-like signal
- Secondary drivers: degenerative axial load concentration at C5-C7 and T12-L2
C. Age-Adjusted Reference Values
Age at current XR: 39 years
| Domain | Age-adjusted positioning |
|---|---|
| SI structural burden | Mild visible abnormality for age; stable and non-destructive |
| SI MRI signal burden | Mild; above strict normal but low-grade |
| Cervical degeneration | Mildly above expected for age in lower cervical segments |
| Lower thoracic degeneration | Mildly above expected for age |
| Thoracolumbar/upper lumbar degeneration | Most above-expected-for-age focus in this case |
| Lumbar MRI L5-S1 burden | Mild / low-end degenerative burden |
| Hip OA burden | Below clinically meaningful OA threshold |
Age-normalized deviation proxy (0–1)
| Region | Value |
|---|---|
| SI XR | 0.30 |
| SI MRI signal burden | 0.34 |
| Cervical spine | 0.38 |
| Thoracic spine | 0.34 |
| Thoracolumbar/upper lumbar spine | 0.48 |
| L5-S1 MRI | 0.22 |
| Hips | 0.14 |
D. Symmetry & Balance Metrics
| Structure | Symmetry class | Asymmetry index |
|---|---|---|
| SI joints XR | Low asymmetry | 0.10 |
| SI marrow-edema-like MRI signal | Symmetric bilateral | 0.05 |
| Hips | Low asymmetry | 0.08 |
| Femoral head-neck offset contour | Mild left-dominant | 0.14 |
| Upper-extremity median neuropathy | Bilateral, right-left similar severity range | 0.12 |
| Lower-extremity neurophysiology | Symmetric normal | 0.02 |
Coronal/sagittal balance proxy
| Parameter | Estimated value |
|---|---|
| Lumbar coronal curve | ~8–10° levoconvex |
| Cervical lordosis loss class | Mild |
| Thoracolumbar junction load concentration | Present |
| Pelvic rotational artifact on XR | Mild |
E. DEXA–Radiograph Correlation Summary
No DEXA dataset was provided. DEXA-linked outputs remain non-computable.
| Metric | Status |
|---|---|
| BMD / T-score / Z-score linkage | Unavailable |
| DRI | Not computable |
| BADA | Not computable |
| CTDM | Not computable |
| DEXA–Radiograph Concordance Grid | Not computable |
Radiograph/MRI-only bone-health proxy: no compression fracture, no femoral head collapse, no destructive marrow lesion reported.
F. Composite Structural Metrics
| Metric | Value | Class |
|---|---|---|
| Composite Stability Index | 0.91 | High stability |
| RSI | 0.95 | Stable |
| CDTI | 0.22 | Low drift / Class I |
| CDC-adjusted confidence | 0.88 | High-moderate |
| Structural asymmetry composite | 0.10 | Low |
| Degenerative burden composite | 0.56 | Moderate focal / mild global |
| Inflammatory-destructive burden composite | 0.24 | Low |
| Neuro-structural discordance composite | 0.41 | Moderate discordance in upper extremities due to CTS not cervical radiculopathy |
| Mixed-pattern divergence index | 0.32 | Mixed, degenerative-predominant with mild SI inflammatory/reactive overlay |
Formula notes
Case-level outputs are proxy values derived from structured report text and validated image-based XR core; MRI and EMG/NCS here are report-text based rather than direct source-image re-read.
G. QA / Reliability Indicators
| Indicator | Value | Comment |
|---|---|---|
| XR descriptor completeness | 0.97 | Full multiregion capture maintained |
| Matched longitudinal confidence | 0.89 | Strong for SI XR only |
| MRI report-text integration confidence | 0.84 | Based on outside-report transcription, not direct MRI image review |
| EMG/NCS report-text integration confidence | 0.86 | Based on report transcription |
| Small-erosion exclusion confidence | 0.66 | Tiny SI inferior notches remain low-confidence |
| Cross-modal concordance confidence | 0.79 | Moderate |
| QCL-style concordance proxy | 0.90 | High internal coherence after rebuild |
| Missingness penalty | 0.11 | No prior thoracic/lumbar/cervical XR match; no DEXA |
A. Prototype Composite Metrics
| Experimental metric | Value | Interpretation |
|---|---|---|
| Exploratory Stability Curve Area | 0.90 | Plateau / stable course |
| Junctional Degeneration Concentration Index | 0.72 | High concentration at T12-L2 |
| Non-Ankylosing SI Persistence Index | 0.95 | Persistent, stable, non-ankylosing SI pattern |
| SI Signal–Structure Coupling Index | 0.68 | Mild MRI signal over chronic stable XR changes |
| Neuro-Imaging Divergence Index | 0.58 | Moderate divergence: bilateral CTS symptoms/EMG are not explained by cervical root disease |
B. Extended Bone-Health Models
No DEXA provided; radiograph/MRI-only experimental bone-health proxies:
| Metric | Value |
|---|---|
| Vertebral fragility suspicion index | 0.08 |
| Collapse-risk imaging proxy | Low |
| Radiographic mineralization deviation proxy | 0.22 |
| Marrow-lesion destructive concern vector | Low |
C. Infection / Oncologic Advanced Operators
| Operator | Output |
|---|---|
| Infection-pattern vector | Low |
| Oncologic-pattern vector | Low |
| Destructive marrow lesion vector | Low |
| Therapy-response signature | Not assessable |
No report-text evidence of discitis/spondylodiscitis, marrow-destructive lesion, epidural process, or oncologic osseous pattern.
D. Advanced Symmetry Maps
| Higher-order metric | Value |
|---|---|
| SI spatial asymmetry gradient | 0.12 |
| Hip shape asymmetry gradient | 0.15 |
| Whole-study bilateral asymmetry composite | 0.11 |
| Median neuropathy symmetry class | Bilateral near-symmetric CTS phenotype |
| Lower-limb neurophysiology symmetry class | Symmetric normal |
E. Genetic / Developmental Modulation
| Field | Output |
|---|---|
| Developmental modulation signal | Low |
| Dysplasia-like geometry signal | Low–mild, limited to subtle head-neck offset loss |
| Persistent non-ankylosing remodeling tendency | Present |
| B27-negative context interaction | No image-only override; morphology remains mixed/stable |
F. External AI Integration Hooks
Provenance-safe research signals
si_definite_erosion = absent
si_ankylosis = absent
si_mri_marrow_edema_like_signal = mild_bilateral
cervical_degeneration_lower_segments = present
thoracolumbar_degeneration_dominant = present
l5s1_mri_bulge_desiccation = present
emg_upper_bilateral_carpal_tunnel = moderate_bilateral
emg_upper_cervical_radiculopathy = absent
emg_lower_large_fiber_neuropathy = absent
emg_lower_lumbosacral_radiculopathy = absent
longitudinal_progression_si_xr = absent
G. QA & Data Integrity Extensions
| Field | Value |
|---|---|
| Clinical core source | Rebuilt XR detection core |
| MRI integration mode | Outside-report text integration |
| EMG/NCS integration mode | Outside-report text integration |
| Region-pairing integrity | High for SI XR; limited for other timepoints |
| Token-scrub compliance target | Maintained |
| Research / clinical separation | Preserved |
| Supersession note | Earlier AI addenda superseded by corrected detection-first rebuild |
Upper extremities: cervical spine MRI/XR vs EMG/NCS
| Root/territory | Structural severity (0–3) | Functional severity (0–3) | Concordance index (0–4) | Flag |
|---|---|---|---|---|
| C5-C6 left foraminal territory | 1 | 0 | 1 | Morphology without functional deficit |
| C6-C7 left foraminal / central territory | 1 | 0 | 1 | Morphology without functional deficit |
| Median nerve, right wrist | 0 spinal root-specific | 2 | 2 | Functional deficit without root-level morphology; CTS pattern |
| Median nerve, left wrist | 0 spinal root-specific | 2 | 2 | Functional deficit without root-level morphology; CTS pattern |
Upper-extremity composite neuro-structural interpretation: electrodiagnostic abnormality is bilateral median entrapment at the wrists, not supported as cervical radiculopathy by the available MRI/EMG reports.
Lower extremities: lumbar MRI/XR vs EMG/NCS
| Root/territory | Structural severity (0–3) | Functional severity (0–3) | Concordance index (0–4) | Flag |
|---|---|---|---|---|
| L5-S1 bilateral foraminal territory | 1 | 0 | 1 | Mild morphology without functional deficit |
| Large-fiber peripheral neuropathy | 0 | 0 | 0 | No abnormality |
| Acute lumbosacral radiculopathy | 0–1 | 0 | 1 | No EMG evidence of root dysfunction |
Lower-extremity composite neuro-structural interpretation: mild L5-S1 structural degeneration without EMG evidence of acute lumbosacral radiculopathy or large-fiber peripheral neuropathy.
This rebuilt addendum supports a stable non-ankylosing bilateral SI structural pattern on longitudinal radiographs, with mild symmetric bilateral SI marrow-edema-like MRI signal but no MRI or XR erosions and no ankylosis. The dominant chronic structural burden remains degenerative, centered in the lower cervical and especially thoracolumbar/upper lumbar spine, while the lumbar MRI shows only mild focal L5-S1 degenerative disease. Neurophysiologic testing adds an important dissociation layer: moderate bilateral carpal tunnel syndrome is present without electrodiagnostic evidence of cervical radiculopathy, and lower-extremity EMG/NCS is normal despite mild L5-S1 morphology. Overall composite profile: mixed but degenerative-predominant structural phenotype, stable over the matched SI radiographic interval, with low-grade MRI SI inflammatory/reactive signal and no destructive progression.
Excerpt; image-derived semiquantitative proxies, not formal central-read scores. Dates de-identified; timing expressed as intervals relative to the current (index) radiographs.
Radiographic series
All projections are shown as de-identified grayscale previews; click any view to enlarge. Only R/L laterality markers appear on the pixels.
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RFull-resolution de-identified images are available by request and in the linked image-compilation PDFs (current / prior).
How case complexity scales
Each axis contributes to and compounds case complexity; the current case sits at the multi-modality tier.
Foundational
Single-date, single-modality structured read — one timepoint, one modality, full per-region descriptor capture.
Longitudinal
Repeat imaging over time adds matched-interval comparison with explicit delta accounting and region-pairing constraints.
Multi-modality
Radiograph + MRI + EMG/NCS read together, with cross-modal concordance and a longitudinal sacroiliac anchor.This case
Full reports & data
conventional readPDF RheumaView · READY+
Gold Standard depthPDF RheumaView · READY
Standard depthPDF RheumaView · READY−
Concise depthPDF Research / Analytics Addendum
22 tables · multimodalPDF MRI reports (4)
cervical / lumbar / SI / prior cervicalPDF EMG / NCS (2)
bilateral UE + LE
De-identified educational / research demonstration. Not medical advice or a diagnostic device. Study dates removed; timing shown as intervals. Analytic values are image-derived semiquantitative proxies, not formal central-read scores.